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Ann Thorac Surg 2004;78:e89-e91
© 2004 The Society of Thoracic Surgeons

Case report

Severe Argatroban-Induced Coagulopathy in a Patient With a History of Heparin-Induced Thrombocytopenia

Hrvoje Gasparovic, MDa, Nadia S. Nathan, MDa, Daniel Fitzgerald, CCPb, Sary F. Aranki, MDa,*

a Division of Cardiac Surgery, Boston, Massachusetts, USA
b Division of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts, USA

Accepted for publication April 12, 2004.

* Address reprint requests to Dr Aranki, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115 USA
saranki{at}partners.org

Heparin-induced thrombocytopenia is a serious complication of heparin therapy, and it remains a therapeutic challenge in the subset of patients requiring cardiopulmonary bypass. Alternative anticoagulation strategies include lepirudin, danaparoid, bivalirudin, and argatroban, or a combination of unfractionated heparin with a platelet antagonist. Argatroban is eliminated by a hepatic route, making it a practical option for patients with renal insufficiency. However, the lack of an effective antidote poses a significant problem. We present a patient with a history of heparin-induced thrombocytopenia with thrombosis who underwent a redo aortic valve replacement. Although the level of anticoagulation achieved with argatroban was initially adequate, its persistence after the completion of cardiopulmonary bypass proved to be life threatening.




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L. E. Samuels, J. Kohout, E. Casanova-Ghosh, K. Hagan, P. Garwood, F. Ferdinand, and S. M. Goldman
Argatroban as a Primary or Secondary Postoperative Anticoagulant in Patients Implanted With Ventricular Assist Devices
Ann. Thorac. Surg., May 1, 2008; 85(5): 1651 - 1655.
[Abstract] [Full Text] [PDF]


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